The Functional Consequences of Rectal Cancer Surgery

摘要

Total Mesorectal Excision (TME) represents the basis of treatment for rectal cancer. Oncological outcomes have improved significantly over the last 20 years, and now there is a shift towards reporting functional outcomes. Bowel, bladder and sexual function are frequently affected following TME, due to the intimate relationship between the rectum and other pelvic structures. 'Anterior Resection Syndrome' is present in 60-90% post-op. The duration of symptoms is quoted between six months and several years. Quality of life alone is not an indication to choose primary anastomosis over end colostomy, but the impact of different surgical techniques on GI disturbance is not well known. Pre-operative radiotherapy is associated with increased stool frequency and incontinence. Sexual function is more commonly affected after rectal surgery than urinary function, particularly in males. Urogenital functional outcomes in females are less well reported. Laparoscopic and robotic surgery allows better visualisation of autonomic nerves and therefore more precise dissection and preservation. It is important that procedures are standardised as much as possible, and that new research into functional outcomes uses validated outcome questionnaires, so that there is a body of homogeneous data available for metaanalysis.